Table 1

Major trials of intensive vs. conventional glucose lowering in subjects with T2D

UKPDS-33 (Int-SU or Insulin)UKPDS-34 (Int-Metformin)ADVANCEACCORDVADT
Subjects (n)3,867753a11,14010,2511,794
Baseline characteristics
  Age (years)5353666260
  BMI (kg/m2)2832283231
  Diabetes duration (years)0081011.5
  Cardiovascular disease history (%)NRNR323540
  HbA1c (%)7.17.27.58.39.4
Glucose-lowering therapy useInt vs. Conv Int vs. Conv Int vs. Conv Int vs. Conv Int vs. Conv
 Insulin (%)38 vs. 16NR41 vs. 2477 vs. 5587 vs. 77b
 Metformin (%)10 vs. 10NR74 vs. 6795 vs. 8760 vs. 54b
 Sulfonylurea (%)54 vs. 25NR92 vs. 5978 vs. 6853 vs. 44b
 TZD (%)17 vs. 1192 vs. 5837 vs. 28b
Results
 Duration of follow-up (years)10.010.75.03.55.6
 HbA1c achieved, Int vs. Conv (%)7.0 vs. 7.97.4 vs. 8.06.5 vs. 7.36.4 vs. 7.56.9 vs. 8.4
 Change in weight to study end (kg)6 vs. 2.51 vs. 1−0.1 vs. −1.03.5 vs. 0.48.2 vs. 4.1
 Change in weight, Int vs. Conv (kg/year of follow-up)0.6 vs. 0.250.1 vs. 0.10.0 vs. −0.21.1 vs. 0.1c1.5 vs. 0.7
 Primary cardiovascular outcome (HR or RR [95% CI])NRNR0.94 [0.84–1.06]0.90 [0.78–1.04]0.88 [0.74–1.05]
 Myocardial infarct (nonfatal) (HR or RR [95% CI])0.79 [0.58–1.09]0.69 [0.35–1.64]0.98 [0.78–1.23]0.76 [0.62–0.92]NR
 Myocardial infarct (all) (HR or RR [95% CI])0.84 [0.71–1.00]0.61 [0.41–0.89]NRNR0.82 [0.59–1.14]
 Myocardial infarct (extended follow-up) (RR [95% CI])0.85 [0.74–0.97]d0.67 [0.51–0.89]d
 Cardiovascular death (HR or RR [95% CI])1.02 [0.66–1.57]NR0.88 [0.74–1.04]1.35 [1.04–1.76]1.32 [0.81–2.14]
 All-cause mortality (HR or RR [95% CI])0.94 [0.8–1.1]0.64 [0.45–0.91]0.93 [0.83–1.06]1.22 [1.01–1.46]1.07 [0.81–1.42]
 All-cause mortality (extended follow-up) (RR [95% CI])0.87 [0.79–0.96]d0.73 [0.59–0.92]d
CommentsYounger, leaner, recent-onset diabetes. Less aggressive glycemic control and moderate weight gain in Int group.Younger, obese, recent-onset diabetes. Less aggressive glycemic control and low weight gain in Int group.Older, leaner, long duration of diabetes. High use of SU and low use of insulin and TZD. No weight gain in Int group.Older, more obese, long duration of diabetes. High use of insulin and TZD and high weight gain in Int group.Older, obese, long duration of diabetes. High use of insulin and high weight gain in Int group.
  • UKPDS (4648), ADVANCE (50), ACCORD (42), VADT (49). Conv, conventional treatment; RR, risk ratio; Int, intensive treatment; NR, not recorded; SU, sulfonylurea. ACCORD and VADT had intensive glucose lowering involving intensive insulin use and were associated with weight gain greater than 1.0 kg/year. Bold typeface indicates significant changes.

  • a Metformin-based intensively treated vs. conventionally treated subjects only.

  • b Glucose-lowering therapy at last recorded study visit.

  • c Measured at 3 years.

  • d UKPDS 10-year post-trial follow-up.